Selective mutism

The term selective (or elective) mutism describes the behaviour of children who are able to speak, but remain silent with certain people or in certain settings; they are often misunderstood and may be wrongly punished for their inability to speak and communicate.

Many children with selective mutism are still being misdiagnosed with autism, oppositional defiant disorder, or learning disabilities.

Children with selective mutism should not be forced to speak, as this leads to worsening of anxiety and mutism. Selectively mute children are not manipulative, nor are they developmentally delayed; they are simply too anxious to speak. It is most commonly noticed when a child joins a school.

A form of social phobia, selective mutism should be treated as such; it has no connection with pervasive developmental disorders such as autism.

The diagnostic criteria for elective mutism are:

Consistent failure to speak in specific social situations (in which there is an expectation for speaking, eg at school), despite speaking in other situations.

The mutism interferes with educational or occupational achievement or with social communication.

The duration of the disturbance is at least one month (not limited to the first month of school).

The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

The disturbance is not accounted for by a communication disorder (eg stuttering) and does not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder.

There are very few children with selective mutism; more of these are girls than boys. There may be a variety of causes. When it persists for a long time teachers and parents may experience high levels of frustration and even anger. It does not help to force a child to speak.

Children tend not to simply grow out of selective mutism, so when the condition persists a planned approach is usually helpful.

Approaches and interventions, which require patience, time and imagination, tend to work best when they occur in the places where the child does not speak. However, the involvement of the parents is critical.

What the school can do to help

It is essential that all adults who come into contact with the child are aware of the difficulty. They must not force the child to speak, but should praise any speech or sound which the child does produce, and possibly use rewards.

Teachers and support assistants can:

Place an emphasis on activities that do not involve spoken language, such as writing, silent reading, and drawing.

Allow the child to communicate by other means such as via the computer.

Place the child in small groups for classroom tasks. A child with selective mutism normally benefits from being in a mainstream class, and from working and playing with other children.

The educational psychologist may be involved in planning an intervention programme for the child. Parents and others, with whom the child does speak, should be involved, but the targeted activities should be carried out at school. As more speech emerges, other people may be involved gradually.

This disability is usually overcome, but the best chance the child has is when the school works closely with parents and outside support services.

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